efarley
New
My surgeon listed this surgery as "T11-T12 transforaminal interbody fusion with posterolateral fusion," and provided CPT 22532 (thoracic fusion by lateral extracavitary technique) for prior authorization by another staff member. There is no CPT code that corresponds with a thoracic interbody fusion - posterior, transforaminal, anterior, or otherwise - in the code book. And, I'm quite sure we cannot use the combined lumbar interbody and posterior fusion - CPT 22633. Can someone please review this operative note and advise me as to what code may best represent this fusion? Please ignore the instrumentation and graft codes.
PREOPERATIVE DIAGNOSES:
1. T11-T12 disk herniation with chronic degenerative changes
2. ...
PROCEDURE:
1. T11-T12 transforaminal interbody fusion fixation with posterior lateral fusion fixation
2. ...
DESCRIPTION: Patient was brought to the operating room, placed in a supine position, and had general anesthesia induced by ET tube. She was turned knee-chest on the Andrews table, positioned, prepped, and sterilely draped. ..[separate lumbar procedure at L4-L5] .. Moved to the T11-12. I made a right-sided paramedian incision about an inch off the midline, exposed the overlying thoracolumbar fascia, divided that, and then dissected down longitudinally through the muscle fibers following a plane down to the transverse process and side of the facet. I exposed the T11-T12 level, verified it radiographically, and put a small self-retaining retractor. Ronguered away about half of the facet, exposed the exiting T11 nerve root. Exposed it enough that I could palpate and see the inferior medial edge of the pedicle and then exposed inferiorly till I got down to the top of the T12 pedicle as well. Coagulated all the epidural tissues and cut into the disk space laterally and then used the disk shavers up to 10 mm in size and curettes to clean out the disk and cartilaginous endplate all the way across. I was actually expecting a fairly sclerotic disk, but it seemed fairly plump with a fair amount of disk material. Took care not to come anywhere or touch teh cord itself and stayed out lateral, and after I was done shaving down the disk and using curettes, I used several trials and ultimately selected a 12-mm tall trial, went in lateral, and then I twisted it. It was a 26 x 12 mm printed DePuy titanium cage. It was filled with a little sliver of Infuse, and I put one whole sponge of Infuse deep to the cage along with the morselized graft from the facetectomy. All packed in deep. X-ray showed it in good position. I then cannulated the pedicle. I could see the pedicle, so I just started with a pilot hole over the back edge and angled first a probe and then a small twist drill through the pedicles. I used 45 mm long 5.0 Expedium screws. I think the medial threads were just slightly through, but I do not think they were causing any kind of a problem. She had fairly small pedicles, and because of the larger screw, it just was inevitable, but they did feel quite tight. Decorticated across the base of the facet at T11-T12 down to the base of the T12 transverse process. Decorticated with the drill, and I left the bone shavings in place and then put a small sponge of Infuse in that area and sealed it in place with a thrombin-soaked Gelfoam powder just to hold everything at least temporarily in place. I then put a rod in place, locked, and finally tightened the screw heads. ...[irrigation and closure]
PREOPERATIVE DIAGNOSES:
1. T11-T12 disk herniation with chronic degenerative changes
2. ...
PROCEDURE:
1. T11-T12 transforaminal interbody fusion fixation with posterior lateral fusion fixation
2. ...
DESCRIPTION: Patient was brought to the operating room, placed in a supine position, and had general anesthesia induced by ET tube. She was turned knee-chest on the Andrews table, positioned, prepped, and sterilely draped. ..[separate lumbar procedure at L4-L5] .. Moved to the T11-12. I made a right-sided paramedian incision about an inch off the midline, exposed the overlying thoracolumbar fascia, divided that, and then dissected down longitudinally through the muscle fibers following a plane down to the transverse process and side of the facet. I exposed the T11-T12 level, verified it radiographically, and put a small self-retaining retractor. Ronguered away about half of the facet, exposed the exiting T11 nerve root. Exposed it enough that I could palpate and see the inferior medial edge of the pedicle and then exposed inferiorly till I got down to the top of the T12 pedicle as well. Coagulated all the epidural tissues and cut into the disk space laterally and then used the disk shavers up to 10 mm in size and curettes to clean out the disk and cartilaginous endplate all the way across. I was actually expecting a fairly sclerotic disk, but it seemed fairly plump with a fair amount of disk material. Took care not to come anywhere or touch teh cord itself and stayed out lateral, and after I was done shaving down the disk and using curettes, I used several trials and ultimately selected a 12-mm tall trial, went in lateral, and then I twisted it. It was a 26 x 12 mm printed DePuy titanium cage. It was filled with a little sliver of Infuse, and I put one whole sponge of Infuse deep to the cage along with the morselized graft from the facetectomy. All packed in deep. X-ray showed it in good position. I then cannulated the pedicle. I could see the pedicle, so I just started with a pilot hole over the back edge and angled first a probe and then a small twist drill through the pedicles. I used 45 mm long 5.0 Expedium screws. I think the medial threads were just slightly through, but I do not think they were causing any kind of a problem. She had fairly small pedicles, and because of the larger screw, it just was inevitable, but they did feel quite tight. Decorticated across the base of the facet at T11-T12 down to the base of the T12 transverse process. Decorticated with the drill, and I left the bone shavings in place and then put a small sponge of Infuse in that area and sealed it in place with a thrombin-soaked Gelfoam powder just to hold everything at least temporarily in place. I then put a rod in place, locked, and finally tightened the screw heads. ...[irrigation and closure]